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PNS Flashcards

1
Q

High Radial nerve palsy usually caused by

A

direct pressure of the nerve as a result of

 1. humeral fracture 
 2. elbow dislocation 
3. prolonged compression “Saturday night palsy”
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2
Q

High Radial palsy Symptoms are

A
  1. unable to extend Wrist MCP joints
    2 extend or radial abduct thumb
  2. decreased sensation dorsum forearm + hand (wristdrop deformity )
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3
Q

Would a person with high radial palsy be able to extend elbow?

A

usually because triceps are usually spared
(supinator + brachioradialis are paralyzed) Elbow flexion and supination are possible because musculocutaneous nerve innervate the bicep

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4
Q

Would a person with high radial palsy be able to flex the elbow? Supinate?

A

yes both are possible because musculocutaneous nerve innervates the bicep.
(supinator + brachioradialis are paralyzed)

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5
Q

What are nerve injuries that cause motor impairments?

A

jk

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6
Q

What are nerve injuries that cause sensory impairments?

A

kfhh

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7
Q

Posterior Interosseous Nerve Syndrome is an injury to what nerve?

A

to radial nerve around the arcade of

Frohse/supinator causing motor problems in wrist and hand

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8
Q

Posterior Interosseous Nerve Syndrome is caused by?

A
  1. entrapment of nerve in supinator muscle 2. elbow dislocation
  2. Poor technique during ORIF of proximal radius FX if hardware pinches nerve 4.compression of radial nerve from
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9
Q

Posterior Interosseous Nerve Syndrome Symptoms

A

unable to extend
MCP joints
extend or radial abduct thumb
able to extend wrist but is radial deviated

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10
Q

Is Posterior Interosseous Nerve Syndrome motor or sensory

A

purely motor pain may be present but it is not primary symptom no sensory

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11
Q

Radial Tunnel Syndrome causes

A

compression/irritation of radial nerve proximal forearm at edge of supinator causing pain in the anterolateral proximal forearm

1. inflammation from repetitive forceful supination pronation of forearm and wrist flexion extension   2. direct blow to the area
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12
Q

Radial Tunnel Syndrome Symptoms

A

Tenderness achiness and pain on the outside of the elbow about 2 inches distal to the lateral epicondyle.

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13
Q

Radial Tunnel Syndrome what increases pain

A
  1. wrist extension
  2. active supination
  3. pronation
  4. holding something with the staight elbow
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14
Q

Does Radial Tunnel Syndrome cause muscle weakness

A

Primarily pain syndrome can cause weakness in wrist extensors making it difficult to steady wrist during grasping and lifting.

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15
Q

Does Radial Tunnel Syndrome cause sensory changes

A

No sensory changes usually because sensory portion of radio nerve branches off the elbow often misdiagnosed for lateral epicondylitis

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16
Q

How may radial tunnel syndrome and lateral epicondyleitis be clinically distinguished from each other?

A

pain from radial tunnel syndrome is usually more PROXIMAL FOREARM area about four fingerbreadths distal lateral condyle

pain from lateral epicondyleitis tends to originate where the TENDON that attaches to the lateral epicondyle

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17
Q

Why is it important to know the difference between radial tunnel syndrome and lateral epicondyleitis thinking treatment stratagies?

A

Common treatment for lateral epicondyleitisis use of elbow strap worn snugly around the proximal for use of the strap will make radial tunnel syndrome symptoms worse by further compressing the radial nerve

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18
Q

What is appropriate body mechanics training for radial tunnel syndrome

A

temporarily avoid task requiring

  1. pronation supination
  2. reaching with arms extended at shoulder 3. level overhead work with wrist flexed forearms pronated
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19
Q

Superficial Radial Nerve Syndrome (Wartenberg’s Syndrome)

strengthing as tolerated

A
  1. close direct trauma or prolonged pressure to rest area 3-4 cm proximal to wrist
  2. surgical pinning for distal radius fx 3. tumor/mass
  3. repetitive ulnar deviation and pronation causing pressure between ECRL and brachioradialis tendons
20
Q

Superficial Radial Nerve Syndrome (Wartenberg’s Syndrome) Symptoms are

A

decreased sensation and/or tingling in the distribution of the radial sensory nerve dorsum of hand radial side

21
Q

Superficial Radial Nerve Syndrome is often made worse by

A

extreme pronation, wrist movement, tight pinching of thumb and index can be uncomfortable at radial aspect of wrist burning pain

22
Q

Superficial Radial Nerve Syndrome is often misdiagnosed for

A

DeQuervain’s tenosynovitis because of location of pain

23
Q

How is superficial radial nerve syndrome and DeQuervain’s differentiated?

A
  • Superficial radial nerve syndrome generally have numbness and tingling over the back of the back of hand
  • DeQuervain’s are not likely to have sensory issues.
24
Q

What splint is used Superficial Radial Nerve Syndrome? What do you need to watch for?

A

thumb spica an incorrectly applied splint will make symptoms of superficial radial nerve syndrome worse. watch tightness of stress and pressure from radial edge of wrist splint
OT intervention thumb

25
Q

Pronator Syndrome is (Rare) but what is the cause?

A

compression of the median nerve in proximal forearm causing pain and numbness in the thumb index long fingers

(most common cause entrapment of the median nerve between the two heads of the pronator teres but there are three other sites a possible compression in this general area)

26
Q

Pronator Syndrome Symptoms

A

Tenderness over pronator teres muscle/volar
forearm is aggravated by resisted pronation of forearm

numbness tingling thumb, index, long, and half ring finger (volar palm) generally no motor involvement

27
Q

Pronator Syndrome causes impairment of which of the following
pain
motor
sensory

A

pain

sensory (numbness)

28
Q

What is the Balentine sign?

A

attempts to perform tip Pinch (okay sign) thumb index the DIP joint collapse
weakness paralysis of hhhh FPL and index FDP

29
Q

What is Anterior Interosseous Syndrome

A

rare entrapment of the motor branch of median nerve in proximal forearm

30
Q

What does Anterior Interosseous Syndrome cause

A

pain and weakness in the thumb index and long fingers

31
Q

What are the causes Anterior Interosseous Syndrome

A
  1. Trauma to elbow forearm area fractured elbow dislocation direct blow causing either direct nerve trauma secondary trauma from hemorrhages
  2. ORIF forearm fracture
  3. Entrapment ORIF forearm fracture compression from fibrous bands in forearm
32
Q

Anterior Interosseous Syndrome Symptoms

A
  • Deep aching pain in proximal forearm increases with activity,
  • weakness of FPL FDP 1+2 and pronator quadratus thus positive Balentine sign and - difficulty picking small items from flat surface usually no sensory problem
33
Q

Does Anterior Interosseous Syndrome impair sensory motor or pain

A

pain is most presenting
some motor (weakness)
usually no sensory problem

34
Q

Carpal tunnel syndrome basic description is

A

compression of the median nerve as it passes through the carpal tunnel associated

35
Q

Carpal tunnel Symptoms are

A

burning tingling numbness pain in palm of hand especially
thumb index and long fingers

Pain can also radiate proximately into the arm

*** grip strength thenar muscles wasting in severe and untreated cases

36
Q

Is swelling visible in Carpal tunnel syndrome

A

no but a persons hand feel the sensation of swelling usually worse at night

37
Q

Laceration to median nerve are usually due to

A

due to knife or glass

38
Q

high-level Laceration to median nerve are usually lacerated at what site

A

elbow or proximal forearm leads to ape hand deformity

39
Q

high-level Laceration to median nerve symptoms

A
  • loss of thener opposition and Palmer abduction
  • some IP flexion
  • thenar atrophy thumb lies to the side of palm
  • paralysis of FDS in the radail half of FDP with their corresponding to lumbricals causing loss of index finger MCP and PIP flexion

-pronator teres is paralyzed so pronation is difficult sensory loss in hand median nerve distribution

40
Q

low-level lacerations to the median nerve are usually lacerated at what site

A

wrist area

41
Q

low-level lacerations to the median nerve symptoms

A

thenar eminence flattening loss of thumb opposition and Palmer of abduction due to paralysis of the median nerve innervated intrinsics sensory loss median nerve distribution of hand

42
Q

What is another name for Cubital Tunnel Syndrome? Give a brief description

A

“cell phone elbow” irritation of the ulnar nerve as it passes superficially of the elbow

43
Q

Cause of Cubital Tunnel Syndrome.

A
  1. stretching nerve prolonged of the flexion

2. pressure on nerves resting elbow on table desk armchair

44
Q

What are the Symptoms Cubital Tunnel Syndrome

A
  • pain along the medial aspect of the elbow and tenderness over cubitul tunnel
  • Numbness tingling in ring and small fingers severe cases will demonstrate intrinsic hand muscle atrophy which can lead to decreased grip strength as well as clawhand deformity due to hand weakness was so positive Fromet’s sign positive Wartenburg sign
45
Q

In severe cases of Cubital Tunnel Syndrome what may happen

A

will demonstrate intrinsic hand muscle atrophy which can lead to decreased grip strength as well as clawhand deformity due to hand weakness

46
Q

What is Fromet’s sign

A

tests for the action of adductor pollicis, which is weak with an ulnar nerve palsy.

A patient is asked to hold an object, usually a flat object such as a piece of paper, between their thumb and index finger (pinch grip). The examiner then attempts to pull the object out of the subject’s hands. A normal individual will be able to maintain a hold on the object without difficulty. With ulnar nerve palsy, the patient will experience difficulty maintaining a hold and will compensate by flexing the FPL (flexor pollicis longus) of the thumb to maintain grip pressure causing a pinching effect.

ORTHO (8 decks)

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